Robert "Bo" Nevarez, 62, senior detective with the Doña Ana County Sheriff's Department, vividly recalls the day he discovered an unusual lump on his neck.

It was a Saturday morning — April 1, 2017 — and Nevarez and his wife planned to go to lunch. He was shaving in preparation to leave when he found the unexpected nodule.

"And I noticed it hadn't been there the day before," Nevarez said. "It was a hard lump. And, it was about the size of a pecan. It was noticeable."

Nevarez had previously read that people should watch for lumps in connection to cancer. And he was aware there are lymph nodes in a person's neck that could be susceptible. So he told his wife, Antoinette, about the discovery, and the two immediately shifted the day's schedule. Before long, Nevarez was being seen by a doctor at a Las Cruces urgent care facility. Nevarez recalls the physician didn't like what he saw.

"He said, had it been a soft lump, he wouldn't have the concerns that he did," Nevarez said. "And his concerns were such that he sent me straight to MountainView hospital."

Dreaded news

Straightaway, Nevarez and his wife went to the hospital, where an ultrasound technician scanned the suspicious mass. At about 4 p.m. that day, Nevarez received a call asking him to stop by to see the doctor "face to face," rather than over the phone. It was at that point the couple received much-dreaded news.

"He said: 'It was cancer,'" Nevarez said. "And with those three words, my life changed forever."

Understandably, Nevarez's mind raced to a worst-case scenario: that he could die from the disease. And his first thoughts were about how Antoinette didn't have all of the passwords to manage their financial accounts. The diagnosis also prompted plenty of worry for the couple. They'd bought a house in recent years and were looking forward to a hopefully-decades-long future together.

"I'd like to think we still have a lot going and ahead of us, and now this," he said.

The diagnosis proved to be the start of a months-long journey that would entail surgery, radiation and chemotherapy in treatment of throat cancer — a broad term that covers cancers affecting tissues and organs in that area of the body. Even more generally, it can be described as a type of head and neck cancer.

Las Cruces roots

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Holding back tears Detective Robert "Bo" Nevarez, with the Doña Ana County Sheriff's Department, talks about his battle with throat cancer, one in which he won and about his brother who battled cancer at the same time who passed away.(Photo: Josh Bachman/Sun-News)

A Las Cruces native, Nevarez has deep roots in the community. He served four years in the U.S. Marines after graduating from Mayfield High School. Upon returning to Las Cruces after his time in the service, he enrolled in the 10th Las Cruces Police Academy, graduating in 1977. After working seven years as a patrolman, he joined the National Guard, eventually being hired to a full-time position. He attended Officer Candidate School and was commissioned as a second lieutenant with the Guard in 1986.

After a stint of full-time National Guard duty, he retired, resuming part-time status. And he returned to Las Cruces in 1995. He wanted to get back into law enforcement, so he applied and was hired at the Mesilla Marshal's Office. To regain his law enforcement certification, he attended and graduated from the Doña Ana County Sheriff's Department's first-ever training academy. He then took a role for two years with Federal Protective Service, before being hired in the county sheriff's department. He worked six months in patrol before being named an investigator — a role he still holds.

Nevarez said the medical coverage he had from his stint in the National Guard, as well as the county's coverage, proved to be invaluable as he launched into his cancer treatment. Absent the coverage, he said he doesn't know how he would have afforded it.

'When it really hit home'

After some wrangling over scheduling, Nevarez's wife was able to secure an appointment within a few days of his initial diagnosis for him to be seen by Dr. Byron Erstine, an ear, nose and throat specialist in Las Cruces. During the first examination, the doctor predicted the tumor would be identified as squamous cell carcinoma — a cancer type that affects skin cells and linings of wide-ranging places on the body. And he sent Nevarez for a biopsy.

Within a week, Nevarez was lying on an operation table in preparation for the procedure. And the realization of what he was about to go through dawned more fully.

The doctor's initial suspicions were correct. It was squamous cell carcinoma affecting his right tonsil and nearby lymph nodes. Fortunately, it hadn't spread to other areas of his body. The cancer was deemed to be Stage IV. But Nevarez's ear, nose and throat specialist was optimistic it could be successfully treated.

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How common is it?

Along with the soft palate, the sides and back of the throat and the back one-third of the tongue, the tonsils are located in a mid-throat region known as the oropharynx. And so cancers affecting those areas can also be referred to as "oropharyngeal cancer," according to cancer.gov.

The American Cancer Society forecasts that 16 out of every 100,000 people in the U.S. will be diagnosed with oral (mouth) and oropharyngeal (mid-throat) cancers in 2018. And 3 of those 16 diagnosed — almost 20 percent of patients — will die from them.

In more than 90 percent of instances, according to cancer.org, cancers affecting the mid-throat and the mouth are squamous cell carcinomas — as in Nevarez's case.

“I felt terrible, but I tried to fight it.”

Doña Ana County Sheriff's Department detective Bo Nevarez

Las Cruces oncologist Dr. Parikshit Padhi, who treats patients at Memorial Medical Center Cancer Center, said throat cancer is not the most prevalent type of cancer he sees locally. Breast, lung, colon and prostate are the most frequent. The incidence of throat cancer can vary by region, based on how much of the population has one of the biggest risk factors: smoking or tobacco product use. Las Cruces has a large retiree population — including people who started smoking before the habit's cancer-causing risk was known — and veteran population. And a lot of veterans have smoked or used tobacco. Because of that, he said, throat cancer does have a presence in the community.

"The most common cause of throat cancer is tobacco, tobacco, tobacco," Padhi said.

What are the warning signs?

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Detective Robert "Bo" Nevarez, with the Doña Ana County Sheriff's Department, talks about his battle with throat cancer, one in which he won. July 17, 2018(Photo: Josh Bachman/Sun-News)

With cancer affecting the tonsils in particular, it's often discovered at an advanced stage because a tumor can grow in that area of the neck without causing any discomfort or becoming readily visible, Padhi said.

"If you notice any swelling in the neck, you definitely need to have a doctor evaluate the swelling in the neck," he said.

Padhi said another indication of mouth or throat cancer can be pain in those areas or difficulty opening the mouth. Prolonged hoarseness, lasting more than a couple of weeks, also should be checked out by a physician.

Cancer physician Dr. Constance Wash, who runs an independent oncology clinic in Las Cruces, also emphasized that cigarettes and tobacco products put people at risk for throat cancer. But the disease is not limited to tobacco users. How people first discover an abnormality can vary.

"Some people feel a mass in their throat," she said. "They have trouble swallowing or have pain in the throat."

Wash said people who use tobacco can reduce their risk for cancer by cutting the habit.

The likelihood of surviving throat cancer, Wash said, typically hinges upon the size of the tumor when first discovered, as well as whether — and how extensively — it's metastasized, or spread to other tissues and organs.

On Aug. 13, MountainView Regional Medical Center opened a small cancer center of its own in a renovated space inside that hospital. The center is able to offer chemotherapy, but will refer any of its patients in need of radiation, as well, to MMC's Memorial Cancer Center.

Starting treatment

Nevarez isn't a tobacco user. And he'll likely never know the cause of his own cancer. Regardless of the cause, an aggressive plan of attack was needed.

In mid-May 2017, he was scheduled for a tonsillectomy — surgery to remove the cancerous tonsil. The surgery went well, but the recovery period was rough.

"I lived on popsicles," he said. "I started to lose some weight."

And he contracted pneumonia soon after, spending nearly three days in the hospital.

On May 27, Nevarez had his first radiation treatment at Memorial Cancer Center. They fitted him for a special mask. For each session, the mask was screwed to a table — immobilizing his head and allowing precise targeting of the area of the neck in need treatment.

Besides the stint in the hospital and time away for doctor's appointments, Nevarez kept going to work, investigating crime in Doña Ana County. He said he wanted to live as normal of a life as possible, in spite of the cancer diagnosis. And he didn't want his co-workers to treat him any differently. Thankfully, they didn't, he said, which helped to boost his morale. He said he received a lot of support from colleagues, supervisors and County Sheriff Enrique "Kiki" Vigil.

He was able to squeeze in six weeks of five-days-a-week radiation treatments by scheduling them before work hours. He'd show up at 7 a.m. for appointments and be in the office at 8 a.m., ready for the work day. In addition, about a week after his first radiation treatment, he underwent the first of three rounds of chemotherapy — the use of drugs to target cancer cells. At first, he wasn't affected by the treatments, but that changed.

"Toward the end of the six weeks, it started to hit me," he said. "I would get tired. There were a couple of times where I'd get called out on a call, and if I was out in the sun, I could feel I was sick."

Finding inspiration

Nevarez said he tried to push through the sickness, avoiding letting it interfere with his work. Even so, the harsh treatments took a toll on his body. He was prescribed a narcotic-type medication, and, by early August 2017, his doctor required that he stay home from his work at DASO. He was off the job for about two months.

The cancer treatment process took a toll on his psyche as well. But Nevarez said his wife helped to keep him from dwelling on the situation and becoming severely depressed. And she was a source of inspiration to get through especially difficult times.

In addition, Nevarez said, because of his military experience, he had pragmatic attitude. In the National Guard, he was required to constantly develop plans of action. From the first day of his diagnosis, he focused upon what steps were needed next. And he did a lot of research on his own about the disease.

"I felt terrible, but I tried to fight it," he said.

Undergoing chemotherapy

Doctors said the treatment for throat cancer will vary by the patient's specific circumstances. In Nevarez's case, he required surgery, radiation treatment and chemotherapy.

Before starting chemotherapy, his doctor warned him that the toxicity of the particular medication involved, Cisplatin, could cause him to lose his hearing. But Nevarez said he was "willing to take the chance."

Each treatment required Nevarez to visit the cancer clinic for a seven- to eight-hour chemotherapy session. He'd take an e-tablet for entertainment and a sack lunch. But, at least toward the end of his treatment, he couldn't eat the lunch. He was experiencing complications that many throat cancer patients experience: difficulty eating and swallowing. This caused him to lose 45 pounds during his cancer battle.

"I had to crush my pills because I couldn't swallow them," he said. "I'd gag when I tried to drink fluids."

Because he couldn't drink fluids and he didn't want to resort to using a feeding tube, his doctor required that he visit the clinic every other day to have fluids intravenously administered. That kept him from dehydrating.

Wash said the toxicity of treatments in such a compact area as the neck does cause complications.

"The main issue is people with this have difficulty eating, and, as it progresses, they can have difficulty breathing," she said.

During treatments, many cancer patients also suffer nausea. Nevarez was prescribed an anti-nausea medication, which he said was successful in countering that. The chemotherapy did cause tiredness, though.

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Aug. 11 marks the one-year anniversary of Doña Ana County detective Robert "Bo" Nevarez's last treatment for throat cancer. It's one of several occasions Nevarez said he now marks as a "cancer-versary."(Photo: Josh Bachman/Sun-News)

Marking milestones

Last month — Aug. 11 — marked the one-year anniversary of Nevarez's last treatment. It's one of several occasions Nevarez said he now marks as a "cancer-versary."

"Cancer survivors, cancer patients, we have several 'cancer-versaries,'" he explained. "You have the day you found out you had cancer. You have the day you start your treatments. You have your cancer-versary for the day you end your treatments. You have a cancer-versary for the day they tell you: 'You're cancer-free.'"

By the end of September 2017, Nevarez was well enough to return to work at DASO. And Oct. 12 of last year was the first round of imaging to check whether the cancer had reappeared. It was the best sort of news.

"It came back NED, which is 'no evidence of disease' or cancer-free," he said. "Of course, no one is ever cancer-free. You're in remission."

Unfortunately, as Nevarez's treatment was winding down, a brother of his in Texas, George Nevarez, was also waging his own fight against liver cancer. Bo Nevarez went to visit him in November 2017. In a heart-breaking moment, his brother shared with him that he wished he'd had throat cancer instead of his own ailment.

"How do you respond to that?" Nevarez said.

His brother died from the disease in February this year. Since then, Nevarez said he's suffered his share of "survivor's guilt," plagued by a perpetual question: Why did he live and his brother die?

He said there's also the lingering concern that his cancer could re-emerge. But so far, he's remained cancer-free. He continues to get periodic check-ups from his doctors.

Living with the reminders

Though he's cancer-free, the effects of the treatment continue to impact him. Nevarez lost 70 percent of his hearing due to the chemotherapy. He got hearing aids but has resisted wearing them because they pick up so much sound it's distracting. He also lives with a constant ringing sound in his ears, a condition called tinnitus. His sense of taste also has dulled, compared to his pre-cancer days. He tries to eat spicier foods to make up for that. His facial hair now grows sparsely. And he developed a condition called lymphedema that requires daily therapy.

Post-treatment, Nevarez woke up one morning with a swollen neck. He said it alarmed him because he thought the cancer returned. However, his doctor identified the swelling as a complication from the cancer treatment.

“I appreciate the small things, and I appreciate people more.”

Doña Ana County Sheriff's Department detective Bo Nevarez

Wash said the condition develops because of interference in the body's lymph system. And lymph fluid, instead of flowing normally, builds up in the body's tissues.

At first, Nevarez said he went to therapy regularly to massage his upper torso and keep it from building up. In between therapy sessions, he had to wear strips of tape on his neck, which promoted fluid flow as he moved his head during normal daily activity. Now, however, a special suit and machine have replaced the therapy visits. It automatically massages his neck, face and torso. Each morning, he wears the suit for nearly 40 minutes, which prevents a lymphedema flare-up.

Given that he's a non-smoker, Nevarez said he's been told he has an 85-90 percent five-year survival rate. Nevarez said it's an "an excellent cancer prognosis."

For now, Nevarez has no plans to retire. He said he enjoys his work as a detective, and he doesn't see a reason to quit. His battle with cancer has given him a new perspective on life.

"I appreciate the small things, and I appreciate people more," he said.

Nevarez recounted celebrating the Fourth of July holiday with his family in 2017. His granddaughter sat on his lap as they ignited fireworks. Amid the happy moment, he recalled wondering: "Am I going to be here next year?"